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General NPI Number Information
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NPI Number | 1538206537
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Entity Type | Individual
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Provider Name | MARCELLE DESRONVIL-LISSADE DMD
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 1111 S POLLOCK ST
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City | SELMA
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State | NC
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Zip | 27576-2933
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Country | US
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Telephone | 919-965-2552
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Fax |
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Provider Business Mailing Address
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Address Line | 2127 CRIGAN BLUFF DR
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City | CARY
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State | NC
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Zip | 27513-8352
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Country | US
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Telephone | 267-981-0360
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8716
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License Number State | NC
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